Diagnosis and Treatment of Bladder (Urinary Bladder) Cancers

What is bladder? The bladder, also known as the bladder or urinary bladder, is located in the lower part of the abdomen and is a spherical organ in which urine accumulates. The kidneys use small channels called ureters to remove toxins from the blood after clearing them from the body. Urine comes to the bladder through small channels and is stored there until it is expelled from the body.

What is bladder cancer?In case of uncontrolled proliferation of cells forming the wall of the bladder bladder cancer occurs. These tumors are usually observed on the inner surface of the bladder with the appearance of a fluffy cauliflower. Bladder cancer is of 3 types;

1. Uropithelial carcinoma: It is a type of cancer seen in the cells lining the bladder wall.

2. Squamous cell carcinoma: It is a type of cancer consisting of squamous epithelial cells of the bladder exposed to long-term infection or irritation.

3. Adenocarcinoma: It is a type of cancer seen in the secreting cells of the bladder. It occurs as a result of abnormal proliferation of cells responsible for the mucus in the bladder wall.

Most bladder cancers are superficial at the time of diagnosis.

75% superficial (limited to bladder mucosa and submucosa)

15-25% invasive (spread to the muscle layer or lymph nodes)

15% metastatic

What are the Causes of Bladder Cancer?

Age

Male Gender (3-4 times more common in males than females)

smoking (2-fold increased risk, responsible for 50% of cases in men and 31% of women, depending on the dose smoked)

Some carcinogens in urine

Exposure to industrial carcinogens

pelvic radiotherapy

Chronic inflammation of the bladder mucosa (bladder stone, long-term catheter)

What are the subtypes of bladder cancers?

Epithelial tumors 98%

Transitional epithelial cell cancer (TCC) 90%

Squamous cell cancer 3-7%

Adenocancer 1%

Mixed tumor 4-6%

Non-epithelial tumors 2%

What symptoms do bladder cancers give?

Hematuria (85%) is the most common symptom. It can be microscopic or macroscopic.

Male over 60 years old, clotted, painless bleeding should bring bladder tumor to mind first.

Bladder irritation symptoms (20%): burning in urination, frequent urination sensation, sudden urination, frequent urination at night.

Occlusive complaints: swelling and side pain in the kidneys if it affects the kidney canal, prostate-like complaints if it affects the prostatic region

If it has metastasized, related complaints: weight loss, loss of appetite, weakness, anemia and cough.

What is the differential diagnosis of bladder cancer?

Bladder inflammation, prostate enlargement, overactive bladder, kidney tumors, renal duct tumors, bladder and renal duct stones.

How is breast cancer diagnosed?

Abdominopelvic Ultrasonography (USG)

Intravenous pyelography (IVP).

Abdominopelvic CT (CT urography): The probability of having a tumor in the upper urinary system at the same time is 1.8%. If the tumor is in trigone, this risk is 7.5%. If there is multiple and recurrence, the risk is high.

MRI

Cystoscopy: The urinary tract is entered into the bladder with a thin lighted instrument. All parts of the bladder are directly observed. Detailed information about the presence, number and location of the tumor is obtained. Bladder tumors detected during cystoscopy for diagnosis are completely cleared in the same session. For this purpose, the tumorous tissue is excised, including its base and periphery, with an instrument called a resectoscope.

How is bladder cancer treated?

Treatment of superficial-muscle non-invasive bladder tumor:

If superficial bladder tumors (Ta, T1, CIS) are non-aggressive, single and small, if there is no tumor before, that is, if there is no recurrence, medication can be applied into the bladder after the tumor is completely scraped with TUR-M. However, due to the risk of recurrence of the disease, it can be administered. that is, it may be necessary to perform cystoscopy at certain intervals.

Treatment of muscle-invasive bladder tumors:

Radical cystectomy: If the general condition of the patient is suitable for surgery in tumors that have reached the muscle base but have not gone further, radical cystectomy is performed, in which the entire bladder is removed (including bladder, lymph nodes and prostate in men, uterus in women). After the bladder is removed, a new bladder is created from the patient’s intestines and the urinary channels (ureters) coming from the kidney are connected to this new sac. This urinary bladder is connected either to the normal external urinary tract (urethra) or to the skin on the side of the abdomen.

Chemotherapy: Chemotherapy and radiotherapy (radiation therapy) options can be applied to patients who cannot undergo surgery. When bladder cancer spreads to other organs, chemotherapy and, if necessary, radiotherapy can be applied.

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